Dementia

The Alzheimer's Association has just completed a new survey that asked more than 1,500 adults to share their fears and concerns about getting older, getting sick and/or caring for a family member struggling with dementia.

The Alzheimer's Association has just completed a new survey that asked more than 1,500 adults to share their fears and concerns about getting older, getting sick and/or caring for a family member struggling with dementia.

Dementia is the progressive loss of memory and various other mental functions, including the ability to learn, reason, and judge. This loss of mental functioning impairs the patient's social functioning, and most people with dementia are eventually unable to care for themselves.

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors for dementia include:

Advancing age

Family members with dementing illness

Down syndrome

Apolipoprotein E status (a genetic risk)

Elevated cholesterol

Multiple strokes

Symptoms

Symptoms of dementia generally come on gradually. They often begin mildly and progress over time. Symptoms vary according to the cause of the dementia, but often include:

Increasing trouble remembering things, such as:

How to get to familiar locations

The names of friends, family members

Where common objects are usually kept

Simple math

How to perform usual tasks, such as cooking, dressing, bathing, etc.

How to drive

Bill paying

Trouble concentrating on tasks

Trouble completing sentences, due to lost/forgotten words (This may progress to complete inability to speak.)

Inability to remember the date, time of day, season

Getting lost in familiar surroundings

Mood swings

Withdrawal, loss of interest in usual activities

Personality changes

Slow, shuffling walk

Poor coordination

Slowness and then loss of purposeful movement

Diagnosis

Doctors diagnose dementia by:

Taking an extensive history from the patient and his or her family

Closely observing the patient

Performing a physical exam

Performing mental status and psychological tests

There are no blood tests or imaging studies to diagnose Alzheimer's disease, which is the most common cause of dementia. Tests to rule out other causes of dementia and other medical conditions that may mimic dementia include:

CT or MRI scans of the head - tests that use a computer (CT scan) or magnetic waves (MRI scan) to create detailed images of structures inside the body, in this case the head

Lumbar puncture - collecting a sample of cerebrospinal fluid by inserting a needle between two vertebrae (rarely needed)

Electroencephalogram (EEG) - a test that records the brain's activity by measuring electrical signals from the brain

Doctors must take care not to miss the diagnosis of depression, which often presents like dementia. Unlike dementia, however, depression is highly treatable.

Treatment

Currently there are no treatments to cure Alzheimer's disease or many other types of dementia. Researchers are studying various drugs to see if they can improve the symptoms of dementia or slow its course.

Medications

Medications being used or studied for possible use include:

Cholinesterase inhibitors

NMDA receptor antagonists

Antioxidants ( vitamin E and others)

Estrogens

Anti-inflammatory agents

Gingko biloba (herbal supplement)

Only two types of medications have been approved by the US Food and Drug Administration (FDA) to reduce the symptoms of Alzheimer's disease: cholinesterase inhibitors and more recently, an NMDA receptor antagonist.

Caring for a person with dementia is extremely difficult and exhausting. Primary caregivers (usually spouses or daughters) need emotional support, as well as regular respite.

Prevention

There is no known way to prevent Alzheimer's disease. A healthful diet will prevent vitamin B12 deficiency and lower cholesterol. A healthful diet and exercise can also enhance cardiovascular health, which may delay the onset of vascular dementia. Limiting alcohol intake can prevent dementia from alcoholism, and avoiding drug abuse and practicing safe sex reduces the risk of AIDS-related dementia. There is also some evidence that engaging in mentally stimulating activity over a lifetime may also reduce the risk of Alzheimer's disease.

Mayo Foundation for Medical Education and Research website. Available at www.mayo.edu

The Merck Manual of Geriatrics . 3rd ed. Merck & Co. Inc.; 1995-2000.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.